Provider Demographics
NPI:1417447731
Name:FAZILOVA, YASHUO (RN)
Entity Type:Individual
Prefix:MISS
First Name:YASHUO
Middle Name:
Last Name:FAZILOVA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14460 GRAVETT RD APT 2C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1307
Mailing Address - Country:US
Mailing Address - Phone:347-418-2565
Mailing Address - Fax:
Practice Address - Street 1:144-60 GRAVETT ROAD
Practice Address - Street 2:APT. 2C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367
Practice Address - Country:US
Practice Address - Phone:347-418-2565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY748960163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health